Name *

First Name

Last Name

a. My Patient Portal Forms are Complete (RPQv3 & Demographics).

Yes

b. Please charge my copay to the credit card on file.

Yes

c. I have logged in to my provider's virtual waiting room on Doxy.me with both video and audio. (See step 3 below).

Yes

d. I have sent my most recent insurance cards to the front desk team. *

* If you have changed insurance or will change insurance soon, please text pictures of the front and back to 503-389-1500 *

Yes

No